akaki zoidze - georgia's path to universal coverage

7/29/2019 Akaki Zoidze - Georgia's Path to Universal Coverage

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Georgias Path to Universal

Coverage

March 23

Akaki Zoidze

The study was financially and technically supported by the Alliance for Health Policy and Systems Research, World Health OrganizationCuratio International Foundation 2012


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Country Fact Sheet

Population - 4.6 million, Median Age39years, growth rate -0.3%, Urban 53%

Lower Middle Income Country - GDP per

capita (PPP) - $4.400 (2009)Life Expectancy76.9 years at birth

IMR15.7 per 1,000

Poverty rate 23.3% and Extreme PovertyRate: 9.4% (2006)


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Health Financing Reform Background

Public Expenditures on Health per Capita after major decline increasesbut slowly:

1990: 130$ (estimated)

1995:


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Health Financing Reform Background

Escalating Medical Inflation and Raising pharmaceutical costs

Evidence on increasing Catastrophic Health Expenditures (CHE) : 1999: 2.8%

2007: 11.7%

Low Utilization of Health Services:

< 2 outpatient visits per person

< 6 inpatient visits and 2 surgical procedures per 100 population


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Medical Assistance (Insurance) Programfor the Poor (MAP)

Provides fairly comprehensive benefitpackage and operates through a publiclyfunded voucher program, enabling

beneficiaries to choose their own privateinsurance company (since 2008).

Eligibility is determined by a proxy means

test administered to applicant households.Reapplication is allowed in one year andeligibility is re-evaluated at least once inevery 5 years


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Georgia Case StudyObjectives

Assess Impact achieved: Responsiveness of MIP insurance carriers and providers and

satisfaction of MIP targeted population;

Breadth, scope and depth of the achieved coverage forthe general population

Access to health services and financial protection for MIPtargeted and the general population; and

Other predefined MIP policy objectives established by thestudy:

reaching the poor;

developing private insurance; improving risk pooling in the national health system and making health

insurance products more affordable due to the enhanced national riskpool;

decreasing level of informal payments through legalization of thefinancial flaws in the health system;

empowering an informed citizen with a free choice of provider.


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Coverage of the PopulationIncreasedbreadth, height and depth of coverage

Total population covered by the publiclypaid health insurance increased (from 2% in2006 to app. 50% in 2012 Medical Assistance (Insurance) for Poor 2006-2008

Insurance coverage for civil servants and teachers 2007

Insurance coverage for all under age of 3 and over 65

Package has expanded Inpatient and some outpatient services, with certain exemptions.

Now including limited outpatient drug benefit;

Co-payments eliminated


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Financial Access

MIP shows positive impact in terms of serviceutilization , less expenditure for inpatient servicesand total health care costs, and higherprobability of receiving free outpatient benefitsamong MIP-insured.

Magnitude of MIP impact on poorest third was

more significant where inpatient treatmentcosts decreased by 442.035 GEL and MIP hassignificantly improved the probability ofreceiving free benefits of inpatient andoutpatient services by around 23% for this

group. However, MIP insurance had almost no effect

on the costs of outpatient drugs and primarilyfor chronic patients


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Utilization

Despite improved geographical andfinancial access almost no increase inutilization was observed between 2007-

2010, after the initial spark in 2006 Did not reveal any statistically significant difference

in overall utilization for MIP beneficiaries and non-beneficiaries. However, a moderate 2 per centdecrease in the rate of the self-treatment was

observed among the poorest .


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Financial Protection catastrophic health expenditures obtained using

the HUES 2007-2010 database show dramaticincrease in the shares of population facing thecatastrophic health expenditures from 11.7 percent in 2007 to 24.8 per cent in 2010.

The share of households that were impoverished asa result of the catastrophic health expenditureshave reached 7.1 per cent in 2010

The share of such households with catastrophic

health expenditures in poorest quintile hasincreased from 11.7 per cent in 2007 to 13.3 percent in 2010. However, gradient between thepoorest and richest households in the same perioddeclined more than twice. The same applied to

impoverishment rates


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PPP In MIP

In terms of achieving other implicit and explicit MIP objectives, followingachievements were established by our study that may be attributed to thePPP in realization of MIP:

Partially curbed the health care inflation;

Mobilized more than 150 million GEL in capital investments for health careinfrastructure and achieved a breakthrough in nationwide health caredelivery system restructuring;

Supported the legalization of the financial flows within the health system;

Increased the share of the prepaid resources in the total healthexpenditures;

Supported development of the private insurance industry, with privatehealth insurance accounting for more than 2/3 of the total mobilizedinsurance premium;

Achieved relatively high levels of responsiveness to the needs ofbeneficiaries and beneficiary satisfaction;

The shortcoming that may be attributed to the PPP in realization of MIP:

- Contributed to fragmentation of the national risk pool;

- Has high administrative costs (10-21%?);


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Conclusions (1)

MIP has been instrumental in increasing allthree dimensions - breadth, scope and depthof the population coverage and managed toimprove financial protection of the

beneficiaries against expenditures related to

the inpatient care, which in turn had positiveimpact on financial access indictors for the

general the population, but had limited overalleffect on utilization of health services andfinancial protection for the general populationas measured by the rates of catastrophic

health expenditures and impoverishment.


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Conclusions (1)

benefit from MIP benefit package during the

first three years of implementation hasdetrimentally affected the potential impact ofMIP on financial protection of the population.

Alternative approaches to protecting thesehouseholds might need to be explored, mostimportant of which may be the expansion ofMIP benefit package to cover the reasonable

outpatient drug benefit that will include thecoverage for the leading causes of chronicillnesses such as hypertension and othercardiovascular diseases, bronchial asthma,

gastroenterology disorders, etc.


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Conclusions (2)

It is still unclear, what is the cumulative

effect of using PICs as purchasers forhealth services for the poor funded bythe public.

The recent governmental decision onmajor expansion of MIP coveragewithout PIC and inclusion of additionaldrug benefit are expected tosignificantly enhance the overall MIPimpact and its potential as a viablepolicy instrument for achieving universal

coverage.


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WAY AHEAD

How to proceed?

Depth or Breadth? OrBoth?

The same package toeveryone or .

akaki zoidze - georgia's path to universal coverage

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